Been reading here for awhile and decided to post now that I'm starting to understand the terms and definitions used here.

I'm a 43 yr old male who recently discovered I apparently have secondary hypogonadism. T readings hover around 190-290, with FHS and LH both very low. I now have some ED issues, but a good sex drive. I've noticed much irritability, weakness at the gym and weight gain around the middle despite good diet & exercise. I apologize in advance for the length, but didn't want to sacrifice accuracy. Thanks to all who do read this and comment.

Let's start with a little history.

I'm 43 and otherwise in pretty good health and shape. About 2 yrs ago I realized I had some inexplicable anxiety and irritability. Out of consideration for my wife & kids I tried Paxil. That lasted for about 1 1/4 yrs until I suspected my T may be off as erections just weren't as firm. Initial tests last fall confirmed this, so my GP suggested Wellbutrin. 4 weeks of that made so even a crane wasn't going to get me up, so I dropped it. I then consulted with a local urologist, who did blood work and found low T. He suggested Androgel, which I tried for about a month with minimal improvement. Seems I'm one of those who doesn't absorb it all that well.

I had a feeling there was more to this and started to really research the issue. Quickly discovered that TRT alone leads to dependency and worse. Many doctors are inclined to just slap an Andorgel bandaid on the problem. I want to fix the root cause, so I consulted with an endo. That was useless- he never heard of using hcg and was another "Androgel is the universal solution" guy. At least he did an MRI to rule out any tumors. Is it possible my 1 1/2 yrs of paxil and 4 wks of wellbutrin could have caused this? Or, was the perceived need for same early T problems in disguise?

I have read with interest here the use of HCG and am strongly leaning towards that, if appropriate. I cannot see deliberately rendering my testicles permanently useless.

By far, the most difficult part of this has been finding a doctor who has a clue and can/will do more than just suggest Androgel. Local doctors don't seem to know a thing. I've gotten more from this and similar boards than all my local doctors put together. I have an appointment in 2 weeks with a supposed expert in hypogonadism at Mass General hospital, but remain skeptical. So far, the only drs I've learned of who have a clue are Dr. John here and Dr Eugene Shippen. Havn't been able to find anyone even remotely in my area even after reading the "how to find a doctor" sticky here, which is very discouraging.

Is there any chance I could actually reverse this? Any other tests/thoughts/ideas? Really not sure what to do-

Any and all thoughts, comments and suggestions are welcome and very much appreciated.

Secondary hypo Im not so sure, but might be used anyways to prevent shutdown. Im more familiar with primary hypo, as in most are usually primary.

What is the reasoning behind secondary hypogonadism? What is wrong with pituitary gland?

What is your estradoil level? Estrogen can decrease pituitary responsiveness to GnRH.

When the hypothalamus senses low hormone levels, it secretes gonandotropin releasing hormone (GnRH). This GnRH then travels a short distance to the nearby pituitary gland to stimulate gonadotrope receptors. These, in turn, secrete the gonadotrophins, luteinizing hormone (LH) and follicle stimulating hormone (FSH). These gonadotrophins travel all the way down to the testis, to activate their respective leydig and seritoli cells. LH initiates testosterone production via the leydig cell receptor (steroidogenesis), while FSH initiates sperm production via the sertoli cell receptor (spermatogenesis). (Link provided below).

Been reading here for awhile and decided to post now that I'm starting to understand the terms and definitions used here.

I'm a 43 yr old male who recently discovered I apparently have secondary hypogonadism. T readings hover around 190-290, with FHS and LH both very low. I now have some ED issues, but a good sex drive. I've noticed much irritability, weakness at the gym and weight gain around the middle despite good diet & exercise. I apologize in advance for the length, but didn't want to sacrifice accuracy. Thanks to all who do read this and comment.

Let's start with a little history.

I'm 43 and otherwise in pretty good health and shape. About 2 yrs ago I realized I had some inexplicable anxiety and irritability. Out of consideration for my wife & kids I tried Paxil. That lasted for about 1 1/4 yrs until I suspected my T may be off as erections just weren't as firm. Initial tests last fall confirmed this, so my GP suggested Wellbutrin. 4 weeks of that made so even a crane wasn't going to get me up, so I dropped it. I then consulted with a local urologist, who did blood work and found low T. He suggested Androgel, which I tried for about a month with minimal improvement. Seems I'm one of those who doesn't absorb it all that well.

I had a feeling there was more to this and started to really research the issue. Quickly discovered that TRT alone leads to dependency and worse. Many doctors are inclined to just slap an Andorgel bandaid on the problem. I want to fix the root cause, so I consulted with an endo. That was useless- he never heard of using hcg and was another "Androgel is the universal solution" guy. At least he did an MRI to rule out any tumors. Is it possible my 1 1/2 yrs of paxil and 4 wks of wellbutrin could have caused this? Or, was the perceived need for same early T problems in disguise?

I have read with interest here the use of HCG and am strongly leaning towards that, if appropriate. I cannot see deliberately rendering my testicles permanently useless.

By far, the most difficult part of this has been finding a doctor who has a clue and can/will do more than just suggest Androgel. Local doctors don't seem to know a thing. I've gotten more from this and similar boards than all my local doctors put together. I have an appointment in 2 weeks with a supposed expert in hypogonadism at Mass General hospital, but remain skeptical. So far, the only drs I've learned of who have a clue are Dr. John here and Dr Eugene Shippen. Havn't been able to find anyone even remotely in my area even after reading the "how to find a doctor" sticky here, which is very discouraging.

Is there any chance I could actually reverse this? Any other tests/thoughts/ideas? Really not sure what to do-

Any and all thoughts, comments and suggestions are welcome and very much appreciated.

What is the reasoning behind secondary hypogonadism? What is wrong with pituitary gland?

What is your estradoil level? Estrogen can decrease pituitary responsiveness to GnRH.

Your case is very interesting. Why not make the trip up to michigan?

Thanks for your input. VERY much appreciated. Allow me to expound a bit.

Prolactin was 6 and Estradiol 32. All new bloodwork is being done tomorrow in preperation for the trip to Mass General to meet the "expert", who is supposedly quite the researcher and well published. We'll see about that. Been burned already, so I'm a bit skeptical.

I could swear I'd seen studies indicating hcg was equally good for secondary, where there is a breakdown in the HPTA axis. My testicles are of good shape/size and do produce some T, hence the tentative diagnosis of secondary. I read Dr John's excellent synopsis set forth above in the sticky which REALLY got me thinking, as he mentions hypogonadotrophic hypogonadism as suitable for hcg. Here is a quote, in pertinent part:

"While HCG, as sole TRT, is still considered treatment of choice for hypogonadotrophic hypogonadism by many, my experience is that it just does not bring the same subjective benefits as pure testosterone delivery systems do—even when similar serum androgen levels are produced from comparable baseline values. However, supplementing the more “traditional” TRT of transdermal, or injected, testosterone with HCG stabilizes serum levels, opposes testicular atrophy, helps rebalance expression of other hormones, and brings reports of greatly increased sense of well-being and libido."

This, my friends, is why I am so interested in hcg! Dr. Crisler's eloquence sums it up nicely.

My concern is that should I permanently shut down what production I have I'd be doing myself a huge disservice. What if medical science advances in the next 10 years and I've permanently shut down my natural abilities? Seems short sighted.
My interest in hcg is twofold. I don't want to permanently shut myself down and I'd like to avoid lifetime dependency.

I may end up having to travel to Michigan as I've been increasingly impressed by what I have been reading about Dr. John Crisler. I'm trying to take this step by step and am holding off doing anything which could have permanent effects until I have a reasonable idea what to do.

Thanks, JanSz- I had most of those tests done, but see I few I missed. (m)

Didn't post them all in the interests of brevity. Tomorrow's blood work will include T (all), FSH, LH, prolactin, Estradiol and SHBG, etc. These were specifically requested by the "expert" at Mass General. Doing them locally to save time.

I fear that when all is said and done I'm going to end up travelling to Lansing, Michigan to see Dr. John. In fact, I'm going to start calling to see what appointments are opening up in the next few months!

I keep asking: Why me? and "What is going on with us as a species and gender? Something is "up" and it's not us (pun intended...).

Didn't post them all in the interests of brevity. Tomorrow's blood work will include T (all), FSH, LH, prolactin, Estradiol and SHBG, etc. These were specifically requested by the "expert" at Mass General. Doing them locally to save time.

I fear that when all is said and done I'm going to end up travelling to Lansing, Michigan to see Dr. John. In fact, I'm going to start calling to see what appointments are opening up in the next few months!

I keep asking: Why me? and "What is going on with us as a species and gender? Something is "up" and it's not us (pun intended...).

I am glad you got tested, good first step.

Would you mind checking list done by your experts and tell me what I missed?

Locally, I had to ask for anything beyond T, FSH and LSH. The local endo did check for cortisol, which was "slightly" elevated.

The specialist asked for only the following: T (all) FSH, LH, Estradiol, SHBG and prolactin. That's it. I go in 2 weeks and will hopefully have more then. If not, then I'd have totally wasted my time.

Despite literally months of research I remain puzzled. The more I look, the more complicated things get. Just learned of Dr. Crisler a short time ago after stumbling across this site by accident.

I have spent literally thousands of hours studying dozens of endocrinology boards/streroids/HRT. Dr John is WELL respected throughout. You could not be in better hands.

Couple points before you go in for bloodwork - Make sure you are well hydrated - Dehydration will temporarily raise T levels. Make sure you also do not have sex that day or night before - that will temporarily raise prolactin levels.

Your cortisol is elevated. Hmmm. The first thing you want to get fixed is your adrenal glands and thyroid. Without those two, HRT is pointless. I would call your DR today and specifically ask him that you want t4 and t3 checked.

Thanks for your input. VERY much appreciated. Allow me to expound a bit.

Prolactin was 6 and Estradiol 32. All new bloodwork is being done tomorrow in preperation for the trip to Mass General to meet the "expert", who is supposedly quite the researcher and well published. We'll see about that. Been burned already, so I'm a bit skeptical.

I could swear I'd seen studies indicating hcg was equally good for secondary, where there is a breakdown in the HPTA axis. My testicles are of good shape/size and do produce some T, hence the tentative diagnosis of secondary. I read Dr John's excellent synopsis set forth above in the sticky which REALLY got me thinking, as he mentions hypogonadotrophic hypogonadism as suitable for hcg. Here is a quote, in pertinent part:

"While HCG, as sole TRT, is still considered treatment of choice for hypogonadotrophic hypogonadism by many, my experience is that it just does not bring the same subjective benefits as pure testosterone delivery systems do—even when similar serum androgen levels are produced from comparable baseline values. However, supplementing the more “traditional” TRT of transdermal, or injected, testosterone with HCG stabilizes serum levels, opposes testicular atrophy, helps rebalance expression of other hormones, and brings reports of greatly increased sense of well-being and libido."

This, my friends, is why I am so interested in hcg! Dr. Crisler's eloquence sums it up nicely.

My concern is that should I permanently shut down what production I have I'd be doing myself a huge disservice. What if medical science advances in the next 10 years and I've permanently shut down my natural abilities? Seems short sighted.
My interest in hcg is twofold. I don't want to permanently shut myself down and I'd like to avoid lifetime dependency.

I may end up having to travel to Michigan as I've been increasingly impressed by what I have been reading about Dr. John Crisler. I'm trying to take this step by step and am holding off doing anything which could have permanent effects until I have a reasonable idea what to do.

What's worse? Having this problem or being unable to find a doctor!

Right. I had a feeling hCG was usefull in both primary(obviously) and secondary hypogonadism.

It is not completely uncommon for one to be both primary(the usual suspect) and secondary hypo. This is common amounst steroid abusers, as drugs involved will cause a shutdown in not only primary mechanisms but secondary as well. Take a look at the pituitary gland and the testical, they LOOK and operate on a very similar level(this is not a coincidence, it is truly amazing to see how the body works in harmony, a true work of God) A little or alot of both can happen. Throw estrogen in the mix and things get real hairy.

The "usual" reasons for the having low T are primary and/or secondary and/or estrogen mucking up T receptors. Your E level is 32, which isn't to bad, but for a guy with a T level in the 300's, that is a bit elevated.

Its still a foggy case, being I can't really say for sure as in I don't know exactly what is wrong with your pituitary gland. That might be a mute point though. I haven't read much in the effect of people having "naturally" fixed secondary hypo.

Keep this post as your journal here. Im curious to see what happens! You have a very interesting case that Im sure a good Dr can get a handle on.

Avoid eating anything out of a box if possible. I buy the usual meat/cheese/eggs/yogurt like everyone else, and I get tons of frozen fruit and frozen veggies in bulk because they are cheap and last forever. Soy is added in processed boxed food.

Avoid alcohol and cigarettes.

No salad dressings as they all are soy derived now. I use olive oil and vin and spices.

There are many ways to combat xenoestrogen naturally threw supplements.

1. Resveratrol
2. ZMA
3. DIM
4. Calcium D Glucarate
5. Vitex

Green veggies are an awesome way to combat them as well. Plus all the added bennies they carry. Buy them frozen in bulk quanities to save on costs and extend lifespan. Frozen veggies retain freshness and quality better as well. Broccoli and spinich are the two kings. But don't neglect the others.

Last but certainly not least, and maybe even the MOST important, is bodyfat. Estrogen is stored and produced in bodyfat. No denying that. One of the best ways you can combat xenoestrogens is to carry a low BF percentage, preferably a single digit BF. Exercise and diet are biggies. :bruce3:

Avoid eating anything out of a box if possible. I buy the usual meat/cheese/eggs/yogurt like everyone else, and I get tons of frozen fruit and frozen veggies in bulk because they are cheap and last forever. Soy is added in processed boxed food.

Avoid alcohol and cigarettes.

No salad dressings as they all are soy derived now. I use olive oil and vin and spices.

There are many ways to combat xenoestrogen naturally threw supplements.

Green veggies are an awesome way to combat them as well. Plus all the added bennies they carry. Buy them frozen in bulk quanities to save on costs and extend lifespan. Frozen veggies retain freshness and quality better as well. Broccoli and spinich are the two kings. But don't neglect the others.

Last but certainly not least, and maybe even the MOST important, is bodyfat. Estrogen is stored and produced in bodyfat. No denying that. One of the best ways you can combat xenoestrogens is to carry a low BF percentage, preferably a single digit BF. Exercise and diet are biggies. :bruce3:

I am 67yo, 5'9", 160#, waist 33", about 6"dia 1" thick slab of fat around belly button, same since I was 15, wonder if shoud liposuction this fat, it would help managing E2.
Cheers; Let me finish my glass of Sandeman Tawny Porto.
I stopped smoking in 1972.